Type of Registration (All Are Welcome)

Team, With VIM Leader

Team, With Non-VIM Leader

Individual, Part of a Team

Individual, Seeking a Team

Phone *

(###)

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Estimated Arrival Date *

MM

DD

YYYY

Estimated Departure Date *

MM

DD

YYYY

What Accommodations Do You Need? *

Overnight Quarters and Hospitality (Not available in all locations.)

Overnight Quarters Only - Able to prepare meals

None

Place to park an RV

Has the Team Leader completed UMVIM Team Leader Training?

Yes

No

Prior Mission Experience

Check all that apply

Some experience, but it has been a while

Habitat For Humanity or similar work

Local Disaster Recovery work

UMArmy

UMVIM US Mission

UMVIM International

Tell us about your team *

Adults Only

Family (all ages)

Youth Team (8th grade and above)

Team Leader Name

First Name

Last Name

Team Leader Phone

(###)

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Team Member 2 Name

First Name

Last Name

Team Member 2 Phone

(###)

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Team Member 3 Name

First Name

Last Name

Team Member 3 Phone

(###)

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Team Member 4 Name

First Name

Last Name

Team Member 4 Phone

(###)

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Team Member 5 Name

First Name

Last Name

Team Member 5 Phone

(###)

###

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Team Member 6 Name

First Name

Last Name

Team Member 6 Phone

(###)

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